Use limitations of alcoholic instant hand sanitizer as part of a food service hand hygiene program

Abstract

The efficiency of either handwashing or use of alcoholic instant hand sanitizers (AIHS) has been reported against normal microflora (NF) or transient microflora (TF) using marker bacteria or viruses. Most studies were performed to support use in health care employing techniques that poorly mimic food service. When AIHS is used alone, application quantity, exposure period, alcoholic concentrations and type influence effectiveness. Relevant to the food industry, little work has been done in order to understand the variables affecting efficacy when handwashing and AIHS are combined. Although AIHS has been suggested as a replacement for fingernail brushes in health care, little is known about either application when heavy soil is present. The experiments described examine the effects of sanitizer quantity on efficacy when used after a standard handwash and use of AIHS to disinfect the nail region when contaminated with high levels of organic soil. In these studies, subjects contaminated hands or nail region with TF marker, either Serratia marcescens in Tryptone soya broth or Escherichia coli JM109 in ground beef, respectively. One hand or selected fingers are sampled to establish TF and/or NF baseline counts. For handwashing and AIHS use, hands were washed with a mild antimicrobial soap (AS) (0.5% triclosan), followed by paper towel drying and application of various quantities of AIHS. With fingernail studies, hands and nail regions were washed with tap water, bland soap (BS), AS, AIHS, BS and AIHS or fingernail brush with BS. Using the combined handwash and AIHS to enhance the hygiene process, there were significant (P ≤ 0.05) increases in efficacy as quantity of AIHS increased, a significant difference in efficacy over handwashing alone is seen only when larger quantities (3 mL and 6 mL) of AIHS are employed. In fingernail studies, overall lower levels of E. coli were removed from artificial vs. natural nails and a statistically significantly (P ≤ 0.05) improvement was seen when a fingernail brush was used over all other methods, including BS wash followed by AIHS.

Effects of various hand hygiene regimes on removal and/or destruction ofEscherichia colion hands

“…Michaels et al . (2003) reported that the combination of hand washing followed by alcohol‐based sanitizer lotion significantly reduced bacterial numbers compared to hand washing alone only when large quantities (3 and 6 mL) of sanitizer were applied.…”

“…Factors affecting alcohol‐based sanitizer effectiveness include alcohol type, alcohol concentration, quantity applied, exposure time and organic load on hands (Kramer et al . 2002; Michaels et al . 2003).…”

“…1999; Toshima et al . 2001; Michaels et al . 2003) and water temperature during washing (Michaels et al .…”

Quantification and variability of Escherichia coli and Staphylococcus aureus cross-contamination during serving and consumption of cooked thick porridge in Lungwena rural households, Malawi

“…Many cultures have a strong tradition of washing hands before eating, but often with cold water and without soap (Hoque, 2003;Hoque & Briend, 1991). Although washing of hands with water alone reduces microbial loads on hands (De Wit & Kampelmacher, 1981;Michaels, 2002;Michaels, Ganger, Chia-Min, & Doyle, 2003), a combination of sanitizers and/or detergents and warm water have demonstrated to be more effective (Cogan, Bloomfield, & Humphrey, 1999;Courtenay et al, 2005;Josephson, Rubino, & Pepper, 1997;Michaels et al, 2003). In Bangladesh, during post-defecation hand washing, women living in the semi-urban rub their hands with soil, soap or ash and rinse them with safer water (tube well water) followed by drying with a clean cloth.…”

Predicting and explaining behavioral intention and hand sanitizer use among US Army soldiers

“…Some researchers who recommend hand sanitizers over soap-water hand washing have pointed out that soap-water hand washing fails to remove biotic or living organisms, and the possibility exists for soap contamination (Cardoso, Pereiraa, Zequimb, & Guilhermettia, 1999). Other researchers have concluded that soap-water hand washing is less efficient than hand sanitizers (Johnson, et al, 2005;Michaels, Gangar, lin, & Doyle, 2003;Widmer, 2000). In 2002, the CDC revised their…”